B R I T I S H J O U R N A L O F P S YC H I AT RY ( 2 0 0 0 ) , 1 7 6 , 4 3 4 ^ 4 3 9
Complementary approaches to the assessment
of personality disorder
The Personality Assessment Schedule and Adult Personality
Functioning Assessment compared
JONATHAN HILL, HAZEL FUDGE, RICHARD HARRINGTON,
ANDRE W PICKLES and MICHAEL RUT TER
Background Current concepts and
measures of personality disorder are in
many respects unsatisfactory.
Aims To establish agreement between
two contrasting measures of personality
disorder, and to compare subject ^
informant agreement on each.To examine
the extentto which trait abnormality can
be separated from interpersonal and
social role dysfunction.
Method Fifty-six subjects and their
closest informants were interviewed and
rated independently.Personality
functioning was assessed using a modified
Personality Assessment Schedule
(M ^ PAS), and the Adult Personality
Functioning Assessment (APFA).
Results Subject ^ informant agreement
on the M ^ PAS was moderately good, and
agreement between the M ^ PAS and the
APFA, across and within subjects and
informants, was comparable to that for
the M ^ PAS.This was equally the case
when M ^ PAStrait plusimpairment
plus impairment scores
and trait abnormality scores were
used.
Conclusions The M ^ PAS and the
APFA are probably assessing similar
constructs.Trait abnormalities occur
predominantly in an interpersonal context
and could be assessed within that
context.
Declaration of interest J.H. was
funded by the Medical Research Council,
and R.H. and H.F. by the MacArthur
Foundation.
434
The concepts and measurements of personality disorder are, in many respects, problematical (Rutter, 1987; Hill & Rutter, 1994;
Hill et al,
al, 1995). Difficulties with measurement have included lack of agreement
among measures, low subject±informant
agreement, substantial comorbidity and
lack of distinctiveness of disorders (Zimmerman et al,
al, 1988; Zanarini et al,
al, 1990;
Oldham et al,
al, 1992; Riso et al,
al, 1994; Dolan
et al,
al, 1995; Tyrer & Johnson, 1996). Clinicians do not generally use existing typologies of personality disorder in assessing
patients (Westen, 1997). The Adult Personality Functioning Assessment (APFA; Hill et
al,
al, 1989) was developed to assess personality functioning as a pattern of interpersonal
and social role performance over substantial periods of time. It appears to assess an
underlying latent variable of personality
dysfunction, and has good interrater reliability and subject±informant agreement
(Hill et al,
al, 1989, 1995). This study was
designed to explore similarities and differences with the modified Personality
Assessment Schedule (M±PAS; Tyrer &
Alexander, 1979).
The PAS
The PAS has been the most extensively used
British standardised assessment of personality disorders. It has been shown to possess
adequate interrater and test±retest reliability (Tyrer & Alexander, 1979; Tyrer
et al,
al, 1983) and to be predictive of treatment outcome (Tyrer & Seivewright,
1988). It was, therefore, appropriate for a
comparison with the APFA. The PAS is a
standardised interview in which the interviewee is asked for information related to
24 personality characteristics, and where
the answer is positive he or she is asked to
provide examples of relevant behaviours.
Ratings for each trait are made on a ninepoint scale from 0±8, on which the ratings
of 0±3 are trait accentuations in the absence
of impairment of social functioning or
distress to the subject or those around him
or her. The scores are combined using
formulae described by Tyrer et al (1988)
to derive either 13 personality disorder
categories, or four summary categories.
The M ^ PAS
Some modifications were made to the PAS
by the authors so that additional questions
could be addressed while retaining the scoring method of the original instrument. The
main purposes of the alterations were: (a)
to provide questions that might improve
subject±informant agreement in the reporting of traits; (b) to enable trait abnormality
and impairment to be assessed separately;
and (c) to add traits that might be relevant
in studies of the families of autistic individuals (Piven et al,
al, 1994). This modified
instrument will be referred to as the
M±PAS throughout the paper. The term
`trait' will be reserved for persistent
cognitive/emotional/behavioural
cognitive/emotional/behavioural patterns
assessed separately from impairment in the
M±PAS.
Low subject±informant agreement has
been a major problem for personality disorder measures (Zimmerman et al,
al, 1988;
Riso et al,
al, 1994) and it is likely that there
are several contributing factors (Hill et al,
al,
1995). One possibility is that subjects and
informants may make different attributions
of the same behaviours. For instance, behaviour reflecting suspiciousness might be
recognised by both subject and informant.
However, the subject may see it as the
reasonable response to a perceived threat
while to the informant it is an overreaction
to a trivial event. This might be overcome
where the subject interview asks about his
or her experience of other people, and the
informant interview about the subject's perception of others. Thus, in the M±PAS for
subjects the `suspiciousness' question was
changed from ``In general how well do
you get on with other people? Do you normally trust them or are you suspicious of
them, at least at first?'' to ``In general do
you find that people are to be trusted?''
The follow-up question then enquired
about the basis of the subject's experiences,
leaving the investigator to form the judgement as to whether this amounted to significant level of inappropriate suspiciousness.
Similar changes, reflecting the likelihood
that subjects and informants might interpret the same behaviours differently, were
made to most of the PAS questions.
T H E PA S A N D A P F A C O M PA R E D
The relationship between trait and impairment is fundamental. In the PAS it is
assumed that ``each person possesses a small
and distinct group of primary traits that persist over time and exhibit a high degree of
consistency across situations'' (Millon,
1987) and that those with personality disorder ``. . . would develop personal and
social dysfunction as a consequence of excessive prominence of these traits . . .''
(Tyrer & Alexander, 1988). Thus, trait
and impairment are conceptualised as
separable and by implication could be measured independently. Furthermore, there
might be variability in the extent of association between abnormal trait and impairment and investigation of factors
associated with such variation could be
important. For these reasons the ratings of
trait and impairment were separated in the
M±PAS. In order to do this four dimensions
of trait abnormality were identified: (a)
threshold; (b) intensity; (c) persistence and
(d) pervasiveness. A rating of `zero' was
made where the trait was absent and of
`one' where it was present and either only
affected feelings or was associated with
behaviours that were normal and appropriate. The rating of `two' required that
behaviour was affected and either that there
was a low threshold for the response or that
there was a high intensity of behaviour.
Where there was both low threshold and
high intensity a rating of at least `three'
was made. Ratings from `three' to `six' were
all at the same level of threshold and intensity but reflected whether the behaviours
were seen continually or episodically, and
whether they were pervasive. The numbers
of subjects scoring on each of the four severe
trait ratings was low and so for analyses
presented in this paper ratings in the range
`three' to `six' were collapsed yielding a trait
scale of `zero' to `three'. Impairment was
rated on a `zero' to `five' scale where `one'
reflected `some' impairment and points
between `two' and `five' reflected significant
impairment of different severity and pervasiveness. For the analyses presented here
`zero' and `one' were coded as `zero' so that
the ratings from `one' to `four' represented
varying levels of significant impairment.
These two scales of trait (0±3) and
impairment (0±4) can be handled separately
or combined to create a 0±7 scale. This
closely parallels the points on Tyrer's scale,
omitting the score of `eight' which could be
rated on the PAS only where impairment
was so severe that the person was incapable
of independent functioning.
The APFA
The APFA has been described in detail in
previous papers (Hill et al,
al, 1989, 1995).
In brief, it provides a standardised assessment of a person's functioning in a range
of social domains, with the aim of both
identifying dysfunction that is specific to
particular domains and measuring social
dysfunction that is pervasive. Ratings of
`zero' to `five' are made in each of six domains and the sum of these scores is taken
to reflect the severity and pervasiveness of
dysfunction. Detailed rating rules, a dictionary of examples and training, ensure
that the individual's contribution to functioning, over substantial periods of time,
and where possible free of DSM±IV Axis I
symptoms, is rated.
This study had three aims. The first was
to establish subject and informant agreement using the modified PAS, and to compare this with that obtained with the
APFA (Hill et al,
al, 1995). The second was
to examine agreement between the M±PAS
and the APFA, in order to establish whether
these two contrasting measures appear to
assess similar constructs. Third, the
differences between the two measures
were exploited to examine the extent to
which trait abnormality can be separated
from interpersonal and social role
dysfunction.
METHOD
are comparisons of the APFA and the M±
PAS between subjects and informants, thus
providing a stringent test of agreement
between the instruments. Details of the
establishment of the subject±informant
pairs were given in a previous paper (Hill
et al,
al, 1995). In brief, where the subject
was married or cohabiting the spouse or
cohabitee acted as the informant, and all
married or cohabiting subjects acted both
as subject and informant. Where the subject
was living alone the identification of the
best available informant was done through
discussion with the subject after the purpose of the study had been explained. This
study was designed so that blindness
between subject and informant interviews
and ratings was ensured. Thus, no one
interviewer interviewed both subject and
informant. As a result of the design constraints arising from the comparison of
two forms of the SADS±L (Harrington et
al,
al, 1988) within one source of information,
the interviewers were not balanced over
subject and informant sources. In all, 19
subject and 10 informant interviews were
carried out by R.H., 19 subject and 10
informant interviews by J.H. and 18 subject
and 36 informant interviews by H.F. The
possibility that this lack of balance was
leading to interviewer effect being confounded with subject±informant effects
was excluded by checking that the pattern
of findings was consistent across interviewer pairs.
Sample
The sample was the same as that used in an
examination of subject and informant
agreement using the APFA (Hill et al,
al,
1995). In brief, it was designed to provide
an adequate spread of functioning over
which to examine the performance of the
PAS and the APFA, although all of the subjects were able to support themselves in the
community. There were 42 parents (21
men, 21 women) of children attending the
Maudsley Hospital Children's Department,
and 14 patients (six men, eight women)
attending the Adult Out-Patient Department of the Maudsley Hospital with longstanding, non-psychotic problems. Thus,
there were in all 56 subjects (27 men, 29
women) with an age range of 23±69 years,
a mean age of 41 years, and a median age of
40 years.
Subject ^ informant comparison
In this paper subject±informant comparisons using the M±PAS are presented, as
RESULTS
Interrater reliability
Interrater reliabilities for the trait plus
impairment scores were assessed for three
raters (R.H., J.H., H.F.) who each rated
audio tapes of 21 interviews. Intra-class
correlation coefficients (ICCs) are a widely
used measure of agreement (Bartko &
Carpenter, 1976) and these are shown in
Table 1 together with 95% confidence
intervals (CIs).
Subject ^ informant agreement
Subject±informant agreement was estimated for the combined trait and impairment scores and for traits only, using the
M±PAS. When 0±7 scales were used, calculated from the sum of the traits and
impairments, as described earlier, the intraclass correlations and 95% CIs shown in
Table 1 were obtained. The majority of
the ICCs were low. For the personality
435
HI
HIL L E T AL
attributes `lability' and `aloofness' this was
probably attributable to low interrater
reliability, but for the remainder there
appeared to be low subject±informant
agreement. A very similar pattern was seen
when the traits scored on a 0±3 scale were
entered, and only the ICCs for aloofness,
impulsiveness, aggressiveness, irresponsibility, childishness, resourcelessness and
dependence were significant at P50.01.
The PAS yields scores and categories for
13 types of personality disorder, and these
can be combined to form four main disorders. The scores were calculated using
the combined trait and impairment scales
according to the method described by Tyrer
et al (1988) and subject±informant agreement computed. ICCs for each of the 13
disorders, and for the four main disorders
are shown in Table 2, as are the Kappa statistics for these disorders where there were
either subject or informant based ratings
of disorder in over 10% of cases. All of
the disorders that contribute to the overall
`anti-social disorder' showed moderate
and significant levels of subject±informant
agreement (sociopathic, explosive and
sensitive±aggressive) and this was the case
in two out of the three that contribute to
the dependent disorder (passive±dependent
and histrionic). The sum of all of the M±
PAS trait plus impairment scores may be
taken as an overall index of extensiveness
and severity of personality dysfunction,
and the ICC comparing subject and informant total scores was 0.40 (95% CI 0.16±
0.59, P50.001).
A category of personality disorder was
required using trait scores only, in order
to make comparisons with personality
disorder defined by M±PAS traits plus
impairment, and with the APFA. Trait
ratings of `three' were used as these had
been defined as reflecting high severity
and low threshold, and hence were likely
to be most appropriate to the identification
of personality disorder. Examination of the
distribution of the ratings indicated that if a
cut-off of four or more trait ratings of
`three' were used, this would yield 13 individuals with personality disorder based on
subject interviews and 14 from informant
interviews. This was similar to the number
that was generated using Tyrer's rules for
deriving personality disorder on the basis
of trait plus impairment scores. To what
extent were they identifying similar individuals? On the basis of subject ratings there
were five disagreements between the two
methods with a Kappa of 0.73 (P
(P50.001,
436
Table
Table 1 Estimates of interrater reliability and subject^informant agreement for M^PAS trait plus
impairment scores
Personality attribute
Interrater reliability (n
(nˆ21)
21)
Subject^informant agreement (n
(nˆ56)
56)
ICC (95% CI)
ICC (95% CI)
Pessimism
0.63
(0.30^0.83)
0.19
Worthlessness
0.52
(0.14^0.77)
0.00
0.29
Lability
0.32
Anxiousness
0.75
(0.49^0.89)
Suspiciousness
0.72
(0.44^0.88)
0.16
Introspection
0.69
(0.39^0.86)
0.01
Shyness
0.61
(0.30^0.83)
Aloofness
0.31
Sensitivity
0.75
Vulnerability
Irritability
0.07
0.11
0.21
(0.49^0.89)
0.07
0.40
(0.00^0.70)
70.04
0.71
(0.42^0.87)
0.27
Impulsiveness
0.76
(0.49^0.89)
0.44
(0.21^0.63)
Aggressiveness
0.81
(0.60^0.92)
0.56
(0.35^0.71)
Callousness
0.88
(0.74^0.95)
0.33
(0.08^0.60)
Irresponsibility
0.82
(0.61^0.92)
0.48
(0.25^0.65)
Childishness
0.32
(70.12^0.65)
0.37
(0.13^0.57)
0.26
(0.01^0.49)
0.57
(0.37^0.72)
^
Resourcelessness
^
Dependence
Submissiveness
0.60
(0.25^0.81)
0.00
Conscientiousness
0.50
(0.22^0.80)
70.08
Rigidity
0.70
(0.41^0.87)
70.02
Intraclass correlation coefficients (ICCs) are given where the characteristic was rated in 10% of subjects by at least one
rater. 95% CIs are given for ICCs that were significant at P50.01.
Table
Table 2
Subject^informant agreement for M^PAS personality disorder categories (Kappas) and total scores
(intraclass correlation coefficients (ICCs))
Kappa
ICC (95% CI)
13 personality disorder categories
Sociopathic
0.39**
Passive^dependent
0.57***
(0.37^0.72)
0.54***
(0.33^0.70)
70.05
Anankastic
0.08
Schizoid
Explosive
0.51***
0.58***
(0.38^0.73)
Sensitive^aggressive
0.29*
0.48***
(0.25^0.65)
Histrionic
0.30*
0.52***
(0.31^0.69)
0.12
Asthenic
Anxious
0.15
Paranoid
0.09
Hypochondriacal
0.41***
Dysthymic
0.18
Avoidant
0.11
(0.18^0.61)
Four groups
Antisocial
0.56***
0.56***
(0.35^0.71)
Dependent
0.20
0.43***
(0.20^0.62)
0.24*
0.06
Inhibited
Withdrawn
0.19
The significance of the Kappa and ICCs are indicated by *P
*P50.05, **P
**P50.01, and ***P
***P50.001. Kappas were calculated
where personality disorder was rated either for subject or informant in at least 6/56 cases.
T H E PA S A N D A P F A C O M PA R E D
s.e.ˆ0.112),
s.e. 0.112), and for informant-based
ratings, 10 disagreements and a Kappa of
0.44 (P
(P50.001, s.e.ˆ0.147).
s.e. 0.147).
It has been argued (Tyrer, 1987) that
subjects with personality difficulties may
be unable to describe their own deviant
traits and so are likely to under-report
when compared with informant accounts of
their functioning. Possible under-reporting
of deviant personality characteristics by
subjects was examined by comparing the
means of subjects and informants item by
item. In comparisons of the 24 personality
attributes subject interviews led to significantly higher ratings on suspiciousness
(two-tailed t-test, P50.05) and submissiveness (two-tailed t-test, P50.01). In a
comparison of the scores for the 13 personality disorder types the subject-based schizoid mean score was significantly higher
than that of the informant-based score
(two-tailed t-test, P50.05) and there were
no significant differences in the mean scores
for the four principal personality disorder
types. Given that two out of the three
`significant' differences were in the opposite to the predicted direction and that
around two differences at P50.05 could
have been expected by chance there was
no evidence that subjects underestimated
their deviance.
Relationship between M ^ PAS
and APFA
While the M±PAS and APFA are in many
respects designed to perform different
tasks, both may be used to identify presence
or absence of personality disorder and their
total scores may be taken to reflect severity
of disorder in a similar fashion. Comparison of M±PAS and APFA ratings derived
from the same source (subject or informant)
is limited because the interviews were not
carried out blind, to each other and,
Table 3
therefore, are open to an over estimate of
agreement. By contrast, comparisons of
subject APFA scores with informant M±
PAS scores and subject M±PAS scores with
informant APFA scores are particularly severe tests in which subject±informant differences are likely to place a ceiling on the
agreement that can be achieved between
the instruments. Agreement between the
PAS and APFA within and between subjects
and informants is shown in Table 3.
The top row shows the agreement
between the total M±PAS trait plus impairment scores and total APFA level
scores. The agreement was moderately
good, even when the different instruments
were compared across subject and informant ± the correlations of 0.48 and 0.59
are comparable to, if not better than, the
correlation coefficient of 0.40 that was
obtained for the subject±informant agreement using the M±PAS. It is evident in
the second row that agreement between
the M±PAS and APFA was very similar
when the sum of the M±PAS traits (without impairment) was used. Agreement for
presence or absence of personality disorder
is shown in the third and fourth rows of
the table. The Kappas across subject and
informant were modest but similar to that
of 0.43 for agreement using the M±PAS.
The figures in brackets in Table 3 refer
to agreement between instruments after
the 13 subjects with APFA ratings accompanied by symptoms had been removed.
All but one of the Kappas showed modest
improvements which were due predominately to a reduction in the number of disagreements arising from APFA scores
above the cut off and absence of personality disorder as assessed on the M±PAS.
Thus, within the limitations of the small
numbers there was no evidence that the
M±PAS was vulnerable to the effects of
psychiatric symptoms.
DISCUSSION
Subject ^ informant agreement
on the M ^ PAS
In this examination of inter-rater reliability
of the M±PAS we found similar levels to
those reported elsewhere. Subject±informant
agreement on M±PAS totals of traits plus
impairment scores and on presence or
absence of personality disorder was modest
but better than that reported for DSMbased instruments (Oldham et al,
al, 1992;
Riso et al,
al, 1994). However, in this study
the M±PAS was administered after the
APFA which has been shown to have good
subject±informant agreement (Hill et al,
al,
1995), and so these findings may not
apply when the M±PAS is used independently. Apart from antisocial personality disorder, agreement on the type of
personality disorder was low and this is in
line with the findings of Zimmerman et al
(1988) and Riso et al (1994). Why was
the agreement so poor? Much of the lack
of agreement was attributable to poor
agreement on items on the M±PAS. At least
five reasons for this may be proposed. First,
the items may not be adequately operationalised so that subject and informant are not
referring to the same behaviours. Second,
there may be differences in the type of information that subject and informant make
use of in giving accounts of traits. For instance when asked about anxiousness a
subject is likely to base the reply on feelings, while the informant may be more
likely to infer anxiousness from behaviour.
Third, subject and informant may be sampling from different situations. This is likely
to be the case where the subject refers to
behaviours in intimate relationships to
which the informant does not have access.
Fourth, subject and informant may summarise information differently so that for instance one refers to most severe behaviours
Agreement between M^PAS and APFA based estimates of personality dysfunction for scores and categories
Comparison
Subject
Subject (PAS)
Subject (APFA)
Informant
(PAS and APFA)
informant (APFA)
informant (PAS)
(PAS and APFA)
0.60** (0.67**)
M^PAS variable type
Sum of scores M^PAS trait plus impairment ^ correlations
0.60** (0.60**)
0.48** (0.51**)
0.59** (0.65**)
Sum of scores M^PAS traits ^ correlations
0.60** (0.61**)
0.44** (0.51**)
0.54** (0.56**)
0.54** (0.51**)
Personality disorder M^PAS trait plus impairment ^ Kappas
0.51*** (0.58***)
0.26* (0.38*)
0.44*** (0.48***)
0.51*** (0.59***)
Personality disorder M^PAS trait ^ Kappas
0.55*** (0.61***)
0.28* (0.34*)
0.34** (0.26*)
0.555*** (0.57***)
The significance of the Kappa and intraclass correlation coefficients are indicated by *P
*P50.05, **P
**P50.01 and ***P
***P50.001. Figures in parentheses refer to agreement after removal of
APFA ratings,`accompanied by symptoms'.
437
HI
HIL L E T AL
and the other to typical behaviours. Finally,
there may be a combination of effects of
subject and informant psychopathology.
As we showed in the study of APFA
subject±informant agreement, subjects with
high scores reflecting more personality dysfunction are less likely to have close informants and those available may also be
deviant and hence more unreliable. This
would be consistent with the increase of
disagreement with increase in PAS scores.
Agreement between the M ^ PAS
and the APFA
The agreement between M±PAS and APFA
was as strong when comparing subject and
informant as the agreement between subject
and informant using the M±PAS. This may
in part reflect the fact that the APFA was
administered to the subject or informant
before the M±PAS so may have influenced
it, however, it suggests that the two instruments are, broadly speaking, assessing similar constructs. If that is the case it would
support our previous proposal (Hill et al,
al,
1989; Hill & Rutter, 1994; Hill et al,
al,
1995) that persistent dysfunctional patterns
of social role and interpersonal performance may be common to many of the
personality disorder categories. It is also
consistent with Westen's (1997) finding
that clinicians identify difficulties with intimacy and with work as common personality problems. The implications for
measurement are that when the APFA is
used as a measure of overall functioning,
either as a continuous or categorical variable it identifies personality disorder, while
still enabling those questions relating to
severity, pervasiveness and persistence of
dysfunction that we have identified in
previous papers to be addressed.
Relationship between abnormal
traits and impairment
In the version of the PAS used in this study,
the M±PAS, traits and associated impairment were rated separately, and subject±insubject±informant agreement was similar when traits
alone and the sum of traits and impairment
were compared. The agreement between
M±PAS trait scores, rated without reference
to impairment, and APFA scores was particularly striking. It could be that as interviewers had already assessed patterns of
social role and interpersonal functioning in
the APFA when they administered the PAS
they were inadvertently including impairment in their rating of traits. However, the
438
CLINICAL IMPLICATIONS
& Personality disorder may be assessed in terms of interpersonal and social role
performance.
&
Abnormal traits are generally seen within an interpersonal context.
& Therapeutic approaches designed to improve interpersonal functioning may be
helpful in the treatment of personality disorder.
LIMITATIONS
&
The sample included relatively few subjects with personality disorder.
&
The findings may not generalise to clinical samples with more psychopathology.
The findings may not generalise to those types of personality disorder that were
not represented in the sample.
&
JONATHAN HILL, MRCPsych, Department of Psychiatry, Liverpool University; HAZEL FUDGE, BA, MRC Child
Psychiatry Unit, Institute of Psychiatry, London; RICHARD HARRINGTON, FRCPsych, Department of
Psychiatry, Manchester University; ANDREW PICKLES, PhD, MRC Child Psychiatry Unit, Institute of Psychiatry,
London; MICHAEL RUTTER, FRCPsych, Social,Genetic and Developmental Research Centre, Institute of
Psychiatry, London
Correspondence: Jonathan Hill,University Child Mental Health, Alder Hey Hospital, Eaton Road,
Liverpool L12 2AP
(First received 4 December 1998, final revision 20 October 1999, accepted 26 October 1999)
additional rules had made it clear how each
item was to be judged, and they did not refer
to impairment. An alternative explanation
could be that the distinction between trait
and impairment is in many respects artificial. The majority of the traits refer to behaviours that are seen in an interpersonal
context so that the description of the trait
has to be abstracted from interpersonal examples. In the APFA by contrast the assessment may be seen as being of traits in situ
where they are rated directly. For instance,
if the subject or informant is asked about
the trait of aggressiveness, he or she will
sample or summate from aggressive interpersonal events in order to provide examples, while in the APFA patterns of
relationships and social role functioning
characterised by aggression will be rated.
Future studies
Our findings need to be set against the background of issues to be tackled in the measurement of personality disorder outlined
at the beginning of the paper, and previously
(Hill et al,
al, 1995). It has been important to
show that agreement between two measures
that take different approaches to the assessment of personality functioning is good. The
differences can then be exploited in order to
address key questions in the conceptualisation and measurement of personality
disorder. Further studies will take the
examination further by making systematic
links with ICD- and DSM-based instruments
such as the International Personality Disorder Examination (Loranger et al,
al, 1987).
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Complementary approaches to the assessment of personality
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Personality Functioning Assessment compared
JONATHAN HILL, HAZEL FUDGE, RICHARD HARRINGTON, ANDREW PICKLES and MICHAEL
RUTTER
BJP 2000, 176:434-438.
Access the most recent version at DOI: 10.1192/bjp.176.5.434
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